Recurrence patterns and adjuvant therapy in endometrioid early-stage endometrial cancer with a p53-abnormal pattern
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Objective
Current guidelines recommend different adjuvant treatment strategies for women with endometrioid early-stage endometrial cancer exhibiting a p53-abnormal pattern. We aimed to evaluate recurrence patterns and explore the clinical implications for adjuvant therapy in this population.
Materials and methods
This multicenter retrospective study included 86 patients with endometrioid, p53-abnormal, FIGO stage I–II endometrial cancer treated between 2013 and 2023 at six hospitals in the Republic of Korea. Clinicopathologic data were collected through medical record review. Progression-free survival (PFS) was estimated using the Kaplan– Meier method, and prognostic factors were analyzed using Cox proportional hazards regression models.
Results
The 12-, 24-, and 36-month PFS rates were 91%, 78%, and 76%, respectively. Among the 16 patients who experienced recurrence, 12 (75%) had distant metastases. Adjuvant chemotherapy showed a trend toward improved PFS compared with adjuvant radiation therapy with or without chemotherapy (p=0.10). In multivariable analysis, the p53-overexpression pattern was independently associated with worse PFS compared with the p53-null pattern (HR 8.59, 95% CI 1.61–45.79, p=0.01).
Conclusion
Given the poor PFS, the predominance of distant recurrence and the observed trend toward improved PFS with chemotherapy, adjuvant chemotherapy may be considered in women with endometrioid early-stage endometrial cancer exhibiting a p53-abnormal pattern. Further studies are warranted to clarify the prognostic impact of p53 abnormality subtypes.
